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The impact of inequities, poverty and racism on the health of children

The impact of inequities, poverty and racism on the health of children

By Dianne Oickle (she/her) Dianne Oickle (she/her) on February 27, 2019

This blog is the first of a two-part series on health inequities in early childhood.


“The circumstances in which children are born determine their exposure to environments that promote or compromise healthy development.” [1,(pii103)]

Conditions in early childhood shape our health at all stages of the life course. Exposure to negative conditions in early childhood increases the risk of poor health and further adverse experiences at every subsequent life stage. [2] Enhanced capacity of families and communities through health promoting environments strengthens the foundations that shape health and development across the lifespan. [3] By looking deeper at the levels where early childhood health inequities exist, public health can disrupt the patterns of disadvantage that can be lifelong.

What is the status of early childhood health inequities in Canada?

Canada’s Chief Public Health Officer Dr. Teresa Tam identifies healthy children and youth as one of six priority areas of public health focus in Canada for prevention and promotion where inequities contribute to higher rates of poor physical and mental health. According to Key health inequalities in Canada: A national portrait, [4] a 2018 report from the Public Health Agency of Canada, data on early childhood development are a key indicator of health inequalities that describe a number of patterns of inequities among children: 

  • Health inequities were most pronounced for Indigenous children and those living with low levels of income and higher levels of material and social deprivation.
  • Children living in disadvantaged socioeconomic conditions are at a higher risk for vulnerabilities due to higher rates of parental stress and inadequate housing, as well as less neighbourhood safety and lower quality of child care. 

A 2018 Canadian report card on health equity across the life course [5] showed that only moderate improvements in early learning outcomes have been observed over time. The greatest gains have been made in maternal employment and infant mortality, however the rate of child poverty has risen. This article makes the case for equity-oriented policy level investments to address health inequities, a point reinforced by a 2017 UNICEF report on achieving reductions in child povery [6] through investment in transfer and tax policies for families with children. 

Early child health inequities

Promoting equity in early childhood development for health equity through the life course [7] frames the causes of early childhood inequities in health and development as being rooted in three main areas: [1]  

  1. Socioeconomic, political and cultural. Sustained poverty, lack of universal childcare, inadequate working conditions, income-related nutritional inadequacy and social policies create circumstances that are more difficult to cope with for families living in poverty than the rest of affluent society. 
  2. Daily living conditions. Families in lower socioeconomic circumstances may have less healthy physical and social environments, often lack basic needs and experience multiple complex problems including housing instability, poverty, social isolation, unhealthy physical environments, trauma and victimization. 
  3. Individual health-related behaviours and attitudes, including parent knowledge and skill. 

These areas represent levels of society at which inequities can occur in early childhood, making it more difficult to catch up to the level at which health is more likely. Imagine you have trained for a marathon and gotten an injury during training, but you have to compete in the event anyway. As the race progresses, completing the course feels increasingly difficult, and you fall further and further towards the back of the pack. As you watch those in front of you get further and further ahead, you know there is no way you will catch up no matter how hard you try or how motivated you are.

When it comes to inequities, more privileged families (i.e., runners who trained and raced with no injury) are better able to capitalize on and benefit from rapid social and structural change. However, families who experience marginalization (i.e., runners who trained and raced with an injury) are at a disadvantage, have fewer resources and fall behind as a result of not being able to participate in the opportunities available to the rest of society.

The causes of the cause: Poverty and racism

“While all parents want the best for their children, not all parents have the same resources to give their children the healthiest start in life.” [8(p2)]

A 2018 report from the Robert Wood Johnson Foundation (RWJF) focuses on how two specific determinants, poverty and racism, severely limit opportunities for parents to provide what they know their children need.8 The document, Early childhood is critical to health equity, [8] illustrates how disadvantage due to poverty and racism in early childhood are the basis for the health inequities that result during later stages of life in a number of ways:

  • Poverty and racism limit where families can live. Children living in poverty and experiencing racism are more likely to experience poor living conditions, toxic environmental exposures and a lack of home and community safety.

    If you read this and you are thinking “not in Canada,” think again. Indigenous populations in Canada’s North who experience inadequate housing and lack of food security are one example of what this looks like here at home. 
  • Poverty and racism create chronic stress. Even among those who are highly motivated and knowledgeable, parents living with the realities of poverty and racism are challenged to provide for their children’s needs. Chronic and toxic stress cause physiologic damages in addition to impacting the socioeconomic environments that determine health.

    In the 2013 book Scarcity: Why having too little means so much, [9] the authors also explore the toxic effects of poverty on the brain.
  • Poverty and racism compromise children’s development. The impacts of poverty and racism on children’s development lead to gaps in cognitive and behavioural development. When this happens in the early years, their developmental readiness for school and accompanying life stages is compromised.

The impacts of racism on health are not solely mediated by poverty – racism has an independent and direct impact on health across the life course.  

Figure 1. Pathways through which poverty and racism can lead to poor health in adulthood. [8(p9)]

Click to enlarge

Taking a life course approach to early child health isn’t just about not repeating the cycle; it is more about “breaking the cycles of disadvantage that create and perpetuate enormous health disparities across lifetimes and generations.” [8(p20)] 

The next blog post in this series is called "Multi-sectoral initiatives and relationship building to address early childhood health equity." In it, I will take a deeper look at the importance of multisectoral and relational approaches as interventions to addressing health inequities in early childhood.


Photo credit: Marcel Walker


[1.] Moore TG, McDonald M, Carlon L, O'Rourke K. Early childhood development and the social determinants of health inequities. Health Promot Int. 2015;30(suppl 2):ii102-ii115.

[2.] National Collaborating Centre for Determinants of Health. Pathways to health equity and differential outcomes: A summary of the WHO document: Equity, social determinants and public health programmes [Internet]. Antigonish (NS): NCCDH, St. Francis Xavier University; 2015 [cited 2018 Dec 20]. 12p. Available from:

[3.] Mistry KB, Minkovitz CS, Riley AW, Johnson SB, Grason HA, Dubay LC, Guyer B. A new framework for childhood health promotion: The role of policies and programs in building capacity and foundations of early childhood health. Am J Public Health.2012;102(9):1688-1696.

[4.] Public Health Agency of Canada. Key health inequalities in Canada: A national portrait [Internet]. Ottawa (ON): Government of Canada; 2018 [cited 2018 Dec 20]. 433 p. Available from:

[5.] Blair A, Siddiqui A, Frank J. Canadian report card on health equity across the life-course: Analysis of time trends and cross-national comparisons with the United Kingdom. SSM Popul Health. 2018;6:158-168.

[6.] UNICEF Office of Research. Building the future: Children and the sustainable development goals in rich countries. Florence (IT): UNICEF Office of Research; 2017 [cited 2018 Dec 20]. 56 p. Available from:

[7.] Moore T, McDonald M, McHugh-Dillon H. Evidence review: Early childhood development and the social determinants of health inequities [Internet]. Victoria (AU): Victorian Health Promotion Foundation; 2015 [cited 2018 Dec 20]. 133 p. Available from:

[8.] Braveman P, Acker J, Arkin E, Bussel J, Wehr K, Proctor D. Early childhood is critical to health equity. Princeton (NJ): Robert Wood Johnson Foundation; 2018 [cited 2018 Dec 20]. 35 p. Available from:

[9.] Mullainathan S, Shafir E. Scarcity: Why having too little means so much. 1st ed. New York: Times Books, Henry Holt & Company; 2013.

[10.] Goldblatt P, Siegrist J, Lundberg O, Marinetti C, Farrer L, Costongs C. Improving health equity through action across the life course: Summary of evidence and recommendations from the DRIVERS project [Internet]. London (UK), Brussels (BE): UCL Institute of Health Equity, EuroHealth Net; 2015 [cited 2018 Dec 20]. 14 p. Available from:


Children & YouthRacism/racializationSocioeconomic status